Insuring your health

Who pays for home healthcare?

By Anne Levy-Ward

Cash-strapped governments are shifting healthcare delivery into the home. But if you need more than the government provides, how will you pay for it?

Picture this: Your elderly mother’s arthritis has worsened to the point where she can’t get in and out of the bath without help, she’s becoming increasingly confused, but she’s not ready to go into a nursing home. Or this: You’ve had successful cancer surgery and have been sent home, but you still need some hands-on care to complete your recovery. What’s the solution?

In both instances, it’s home care. Nursing and personal care have long been done in the home, by family members, visiting nurses or paid attendants (if finances permit). But there is a much greater emphasis on home care today, as governments redirect limited resources from higher-cost institutional care to lower-cost home care, and as more (and older) people survive serious illness and surgery to the point that they can go home.

The healthcare system still looks to families to provide front-line care. But if your spouse, siblings or adult children are unable or unwilling — due to distance, job commitments, their own health issues or the complexity of care required — you need to turn to external providers. Government agencies pay for a certain amount of care, but the system can be difficult to navigate. Chances are you will be able to get enough post-op care for yourself, but the amount of care by a personal support worker available for your mother, as a senior with a chronic illness, may be far from adequate.

You can buy additional care, sometimes even from the same agencies that are providing your government-paid care. But home care isn’t cheap: Private home-care service can cost from $20 to $90 per hour for personal or nursing care, according to the Canadian Life and Health Insurance Association.

You may have money put aside for just such a possibility, or you may have long-term care or critical illness insurance. But you may not. The 2013 Sun Life Canadian Health Index found that 20% of Canadians have neither health insurance nor money saved to cover future healthcare expenses. When faced with high healthcare bills and no money specifically put aside to cover them, many have been forced to drain their retirement savings, run up their credit cards or even mortgage their homes.

One way to avoid this scenario when you reach your mother’s age is to get insurance protection while you’re still healthy. Long-term care insurance helps pay for care at home or in a nursing home when you need any of:

Constant supervision by another person because your mental abilities have deteriorated

Substantial physical assistance with at least two activities of daily living (from a standard list of six that includes feeding yourself and dressing yourself)

Stand-by assistance for bathing and transferring (such as moving from a chair or out of bed)

Critical illness insurance pays you a lump sum to use at your discretion if you are diagnosed with one of the serious health issues your policy covers (such as cancer, heart attack or stroke) and you survive the required waiting period. For example, you could use the money to cover any additional care you need after your cancer surgery, or to help replace lost wages if your spouse takes time off to be with you.

If you don’t have a plan to cover potential healthcare expenses, it’s a good idea to talk to your financial advisor about whether long-term care or critical illness insurance is right for you — now, before you need it.